Two years on from the publication of its landmark report—State of Child Health—on the health of children in the UK, the Royal College of Paediatrics and Child Health (RCPCH) released an update on progress towards its recommendations on Jan 23. The report reveals a bleak picture of child health in each of the four UK nations. Commitments towards tackling childhood obesity and improving mental health services for young people are encouraging steps, and the report welcomes the placement of children at the centre of NHS England’s Long Term Plan. However, the ongoing political deadlock in Northern Ireland has stalled child health policy and, worryingly, little or no progress has been made across the four nations on reducing child poverty and inequalities. Indeed, after a decade of harsh austerity, economic hardship has spiralled in recent years. Following several years of decline, child poverty in the UK has increased year on year since 2011–12. Today, more than 4 million children in the UK—or one in three—live in poverty, an increase of 500 000 in the past 5 years. Strikingly, this rise has been driven almost entirely by the increase in poverty among working families, and child poverty rates are predicted to reach a staggering 40% by 2030. The highest rates of poverty are found in deprived urban areas, with ethnic minority groups being hardest hit. Growing up in the grip of poverty has far-reaching and long-lasting repercussions: children born into poor households tend to have lower birthweight and are more likely to die in the first year of life. Notably, infant mortality rose in the UK in 2015 and 2016 after more than 100 years of continuous decline. Children living in poverty are more likely to be obese at age 4–5 years, to have a chronic illness, to die from an accident, and to experience mental ill-health. Adverse outcomes are lifelong, with disadvantaged children having a higher risk of death in adulthood from cancer, coronary heart disease, respiratory disease, and alcohol-related illness. The causes of poverty in the UK are multifaceted and complex, with many factors conspiring to push people into poverty. These include low-paid work and poor job security, rising costs of housing and essential services, and recent changes to welfare support, such as limiting help to two children per family, the cap
on total benefits, and long delays for the receipt of universal benefits. The dire situation was highlighted recently by a report from the UN Special Rapporteur on Extreme Poverty and Human Rights, Philip Alston, following a visit to the UK. The Alston report painted a dismal picture of working families struggling to make ends meet and relying on food banks for their next meal, a complicated and unwieldy benefits system, public services decimated in the name of austerity, and a government “in a state of denial” about the perilous situation. Government ministers meanwhile dismissed the Alston report. And when it was debated in Parliament earlier this month, only 14 Members of Parliament showed up, highlighting how little value the government places on the most vulnerable in society. Funding constraints have led to reduced budgets for public health services at a local level, with spending in 2017–18 on frontline public health services 5% less in real terms than that in 2013–14, with a further £85 million of funding cuts planned for 2019–20. Provision of public health programmes for children aged 5–19 years as well as mandated services for 0–5 year olds, specifically health visiting services, have been drastically cut back, leading to unacceptable variation in the quality and quantity of provision of child health services across the country. Cuts to public health spending do not reflect the health needs of the local population, and many disadvantaged areas with already poor health outcomes have seen substantial reductions in services. The RCPCH calls for an urgent analysis of the impact of the recent public health cuts on child health and a moratorium on further reductions until this has been done. With the threat of Brexit looming, an extended period of financial uncertainty for the country seems inevitable and the consequences for those living in poverty cannot be underestimated. The socioeconomic determinants of health in the UK are deteriorating. Britain feels broken. That one in three children is living in poverty in the world’s fifth largest economy is nothing short of a disgrace. Simply tinkering with plans and procedures will not improve the grim future that lies ahead for many children in the UK unless austerity measures and cuts to front-line public health services are reversed.
www.thelancet.com Vol 393 February 2, 2019